Serologic Presentation of Lamotrigine-Induced Lupus

Area of Science:

• Internal Medicine
• Pharmacology
• Immunology

Background:

• Drug-induced lupus erythematosus (DILE) is a rare autoimmune condition triggered by certain medications.
• Lamotrigine is an anticonvulsant and mood stabilizer commonly prescribed for epilepsy and bipolar disorder.
• Identifying DILE is crucial as symptoms can mimic other conditions, leading to delayed diagnosis and treatment.

Observation:

• A 24-year-old male presented with severe weight loss, weakness, hepatitis, and pancreatitis.
• The patient was on lamotrigine and a selective serotonin reuptake inhibitor (SSRI).
• Initial investigations revealed elevated liver function tests, acute pancreatitis, and a high titer of anti-double-stranded DNA antibodies, but lacked typical lupus symptoms like rash or arthritis.

Findings:

• Positive antihistone antibodies suggested a diagnosis of drug-induced lupus syndrome.
• The patient's symptoms improved after discontinuation of lamotrigine.
• This case underscores the potential for lamotrigine to induce lupus, even without classic dermatological or rheumatological manifestations.

Implications:

• Clinicians should consider DILE in patients on lamotrigine presenting with unexplained systemic symptoms, including hepatitis and pancreatitis.
• Early recognition and withdrawal of the offending agent are key to managing lamotrigine-induced lupus.
• This case contributes to the understanding of rare adverse drug reactions and emphasizes the importance of comprehensive patient history and medication review.